Abstract
BackgroundWe aimed to assess whether longer indwelling time of peripherally inserted central catheters (PICC) increases risk of central line associated bloodstream infections (CLABSI) in haematology patients.MethodsMulticentre retrospective cohort study among haematology patients receiving PICCs between 2013 and 2015. Occurrence of CLABSI based on CDC definitions was assessed. We calculated incidence rates, determined risk factors for CLABSI and used Poisson regression models to assess the risk of developing CLABSI as a function of PICC dwell time. We compared diagnoses and treatment characteristics between 2013–2015 and 2015–2020.Results455 PICCs placed in 370 patients were included, comprising 19,063 catheter days. Median indwelling time was 26 days (range 0–385) and CLABSI incidence was 4.0 per 1000 catheter days, with a median time to CLABSI of 33 days (range 18–158). Aplastic anaemia (AA) was associated with an increased risk of CLABSI; patients undergoing autologous stem cell transplantation (SCT) were less likely to develop CLABSI. In the unadjusted analysis, PICCs with an indwelling time of 15–28 days, 29–42 days, 43–56 days and > 56 days each had an increased CLABSI incidence rate ratio of 2.4 (1.2–4.8), 2.2 (0.95–5.0), 3.4 (1.6–7.5) and 1.7 (0.9–3.5), respectively, compared to PICCs in place for < 15 days. However, after adjusting for AA and SCT, there was no significant difference in incidence rates between dwell times (p 0.067).ConclusionsOur study shows that risk of CLABSI does not appear to increase with longer PICC indwelling time. Routine replacement of PICCs therefore is unlikely to prevent CLABSI in this population.
Highlights
A recurring dilemma in clinical practice is whether we should routinely replace central venous catheters (CVCs) to prevent infections or wait and see if one occurs
The Centers for Disease Control and Prevention (CDC) currently advise against routine replacement of CVCs to prevent bloodstream infections, based on results of randomized studies in critically ill patients [2, 9,10,11,12]. Results of these studies are not translated to the haematology population as CVCs were replaced within several days, whereas peripherally inserted central catheters (PICC) can remain in situ for weeks or even months
All PICCs were inserted at the department of haematology in VU University medical centre (VUmc) and were registered in a prospective database designed for quality purposes
Summary
A recurring dilemma in clinical practice is whether we should routinely replace central venous catheters (CVCs) to prevent infections or wait and see if one occurs. Caris et al Antimicrobial Resistance & Infection Control (2022) 11:37 prolonged use, leading to increasing risk of infection with longer indwelling time [5, 7, 8] This suggests that routine replacement of PICCs may prevent CLABSI. The Centers for Disease Control and Prevention (CDC) currently advise against routine replacement of CVCs to prevent bloodstream infections, based on results of randomized studies in critically ill patients [2, 9,10,11,12]. Results of these studies are not translated to the haematology population as CVCs were replaced within several days, whereas PICCs can remain in situ for weeks or even months. We aimed to assess whether longer indwelling time of peripherally inserted central catheters (PICC) increases risk of central line associated bloodstream infections (CLABSI) in haematology patients
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